SINGAPORE DENTAL COUNCIL

DISCIPLINARY COMMITTEE INQUIRY FOR DR WANG KIT MAN

ON 3 SEPTEMBER 2019, 17 SEPTEMBER 2019,

10 OCTOBER 2019 & 19 NOVEMBER 2019

Disciplinary Committee:

Dr Kaan Sheung Kin (Chairman)

Dr Seah Tian Ee

Dr Lee Chi Hong Bruce

Dr Rachael Pereira (Layperson)

Legal Assessor:

Mr Edmund Kronenburg (Braddell Brothers LLP)

Counsel for the SDC:

Mr Burton Chen

Ms Junie Loh

Mr Jeremy Sia

(M/s Tan Rajah & Cheah)

Counsel for the Respondent:

Mr S Selvaraj

Mr Edward Leong

(M/s MyintSoe & Selvaraj)

DECISION OF THE DISCIPLINARY COMMITTEE

Note: Certain information may be redacted or anonymised to protect the identity of the parties.

Introduction & Brief Procedural History

1. This Decision should be read in conjunction with the Decision of the

Disciplinary Committee In Relation To The Respondent’s Plea of Guilt dated

10 October 2019 (“Plea of Guilt Decision”). The Plea of Guilt Decision

summarises the procedural history leading up to it. The present Decision also

uses the abbreviations defined in the Plea of Guilt Decision, unless otherwise

stated.

2

2. As stated in the Plea of Guilt Decision :-

(a) the Respondent – Dr Wang Kit Man – is a registered dentist practising

at a clinic known as "Q&M Dental Surgery (Simei MRT)" located at 30

Simei Street 3, Simei MRT Station #01-09, Singapore 529888

(“Clinic”);

(b) these proceedings arose out of a Complaint made on 9 January 2017

(“Complaint”) by one Mr P (“Complainant”) in respect of the

Respondent's care and management of one Ms T (“Patient”), who

was the wife of the Complainant;

(c) the SDC appointed a Complaints Committee to investigate the

Complaint. On 31 August 2017, the Complaints Committee informed

the Respondent of its recommendation that the matter be reviewed by

a Disciplinary Committee;

(d) the SDC initially brought five charges against the Respondent in

respect of his care and management of the Patient. After discussions

and correspondence with Respondent’s Counsel, the SDC decided to

proceed only in relation to the two of the original five charges i.e. the

1st and 3rd Charges, with the 5th Charge being taken into account for

purposes of sentencing;

(e) thereafter, the SDC sought to amend, and was granted leave by the

3

Disciplinary Committee to amend, the 1st, 3rd and 5th Charge (in the

form of the Amended 1st Charge, Amended 3rd Charge and Amended

5th Charge, respectively);

(f) the Respondent then sought to plead guilty to the Amended 1st

Charge and Amended 3rd Charge; and

(g) the Disciplinary Committee was – for reasons stated in the Plea of

Guilt Decision – unable to accept the Respondent’s plea of guilt on the

Amended 1st Charge.

3. Following the Plea of Guilt Decision, the SDC withdrew the Amended 1st

Charge. The only remaining charge against the Respondent is therefore the

Amended 3rd Charge, in respect of which the Disciplinary Committee

accepted the Respondent’s plea of guilt. For ease of reference, the Amended

3rd Charge and Amended 5th Charge (relevant only for purposes of

sentencing) are set out below :-

Amended 3rd Charge

3. That you, Dr Wang Kit Man, are charged that on 27 May 2016,

whilst practicing at Q&M Dental Surgery (Simei MRT), 30 Simei

Street 3, Simei MRT Station #01- 09, Singapore 529888, you

failed to keep sufficient records of your care and management

of the Patient.

Particulars

(a) You did not maintain sufficient documentation of the history

and condition of the Patient's tooth #15, that is, the severity

of the mobility of tooth #15 and the nature, duration and

severity of the pain at tooth #15.

4

(b) You did not maintain sufficient documentation of what

investigations you conducted in respect of the Patient's

tooth #15.

(c) You did not maintain sufficient documentation of your

advice to the Patient on alternative treatment options (i.e.

details of treatment options other than the extraction of

tooth #15 followed by implant surgery) and their risks and

benefits.

(d) You did not maintain sufficient documentation of your

advice to the Patient as to the risks and benefits of an

immediate implant fixture placement over that of a delayed

implant fixture placement.

And that in relation to the facts alleged, you have breached

Clause 4.1.2 of the ECG and your conduct demonstrated such

serious negligence that it objectively amounts to an abuse of

the privileges which accompany registration as a dentist,

accordingly you are guilty of professional misconduct within the

meaning of Section 40(1)(d) of the Dental Registration Act,

which is punishable under Section 40(2) of the said Act.

Amended 5th Charge

5. That you, Dr Wang Kit Man, are charged that on 11 June 2016

and 22 June 2016, whilst practicing at Q&M Dental Surgery (Simei

MRT), 30 Simei Street 3, Simei MRT Station #01-09, Singapore

529888, you failed to keep sufficient records of your care and

management of the Patient's post-operative condition.

Particulars

(a) On 11 June 2016, you did not record sufficient detail of the

nature and severity of the Patient's pain.

(b) On 22 June 2016, you did not sufficiently record how the

decision to remove the implant fixture was arrived at.

And that in relation to the facts alleged, you have breached

Clause 4.1.2 of the ECG and your conduct demonstrated such

serious negligence that it objectively amounts to an abuse of

the privileges which accompany registration as a dentist,

5

accordingly you are guilty of professional misconduct within the

meaning of Section 40(1)(d) of the Dental Registration Act,

which is punishable under Section 40(2) of the said Act.

Agreed Facts

4. The following facts are agreed between the SDC and the Respondent:-

(a) On 27 May 2016, the Patient visited the Clinic for treatment of her pain

at an upper pre-molar on the right side. The Respondent attended to

the Patient.

(b) The Respondent arrived at a diagnosis of irreversible pulpitis of the

Patient's tooth #15 without conducting a comprehensive clinical

evaluation of the tooth, in that :-

(i) he failed to take the Patient's history on the nature and duration

of the pain experienced by the Patient on exposure of tooth

#15 to hot and cold stimuli;

(ii) he failed to conduct hot and cold testing to determine and/or

confirm the nature and duration of the pain complained of by

the Patient;

(iii) though the Respondent did a radiographic examination of the

Patient’s tooth #15, the dental panoramic radiographs did not

show significant loss of crestal or apical bone of tooth #15; and

6

(iv) though the Respondent in his clinical examination noted that

tooth #15 was "tender to percussion", this symptom did not

justify his diagnosis of "irreversible pulpitis".

(c) The Respondent conducted the procedure of the extraction of tooth

#15 and an immediate implant fixture placement for the Patient.

(d) As regards the Respondent's keeping of clinical records of his care

and management of the Patient on 27 May 2016, the Respondent

failed to keep sufficient records, in that:

(i) he did not maintain sufficient documentation of the history and

condition of the Patient's tooth #15, that is, the severity of the

mobility of tooth #15 and the nature, duration and severity of

the pain at tooth #15;

(ii) he did not maintain sufficient documentation of what

investigations he conducted in respect of the Patient's tooth

#15;

(iii) he did not maintain sufficient documentation of his advice to

the Patient on alternative treatment options (i.e. details of

treatment options other than the extraction of tooth #15

followed by implant surgery) and their risks and benefits; and

7

(iv) he did not maintain sufficient documentation of his advice to

the Patient as to the risks and benefits of an immediate implant

fixture placement over that of a delayed implant fixture

placement.

(e) By reason of the matters set out at (d) above, the Respondent failed

to keep sufficient records of his care and management of the Patient

in respect of the taking of history and condition of tooth #15,

investigations conducted and advice given on alternative treatment

options as well as the risks and benefits of the treatment that was

carried out, in breach of guideline 4.1.2 of the ECG. This amounted to

a serious negligence on the part of the Respondent that objectively

portrayed an abuse of the privileges which accompany registration as

a dentist.

The Disciplinary Committee’s Decision on the Amended 3rd Charge

5. As stated in the [32] to [36] of the Plea of Guilt Decision, the Disciplinary

Committee found that based on the Agreed Facts, as well as the evidence

placed before it in relation to the Amended 3rd Charge, the Respondent’s

record keeping fell very far below the standards required by Clause 4.1.2 of

the ECG. The Disciplinary Committee also agreed with what the Respondent

himself admitted in the Agreed Facts as regards his own conduct and also

noted inter alia that :-

(a) the Respondent’s handwritten records were in many places, wholly

8

illegible;

(b) the consent-taking process in relation to the Patient was shoddily

documented;

(c) on 12 February 2016, upon the Patient’s first consultation with the

Respondent, the only recorded observation by the Respondent was

“tenderness” on tooth #15, after which he then performed adjustments

of an “occlusal high spot” on tooth #15; and

(d) on 27 May 2016, when the Patient returned and complained of pain in

the upper right quadrant and tooth #15 was “tender to percussion” and

“mobile”, the Respondent failed adequately to record the severity of

this pain and mobility, or other clinical findings regarding tooth #15

sufficient to support his “guarded prognosis”.

6. By reason of the matters stated above, and the totality of the evidence before

the Disciplinary Committee, the Disciplinary Committee found in the Plea of

Guilt Decision that the Respondent’s records came nowhere close to being

“sufficiently detailed” so that any other dentist reading them would be able to

rely on them to take over the management of the Patient’s case from the

Respondent. The Respondent’s conduct fell far short of the mark; it placed

the Patient unjustifiably at risk. The Respondent’s record keeping was so

poor that the Disciplinary Committee concluded that he was either simply

indifferent to the Patient's welfare or indifferent to his own professional duties.

9

7. The Disciplinary Committee accordingly found that the Respondent’s

aforesaid conduct amounted to “such serious negligence that it objectively

portrayed an abuse of the privileges which accompany registration as a dental

practitioner”. It therefore accepted the Respondent’s plea in relation to the

Amended 3rd Charge, and now finds him guilty in relation to the same.

Sentencing

8. In relation to sentencing, the SDC and the Respondent have tendered the

following documents, which the Disciplinary Committee has duly read and

considered :-

Tendered by the SDC

(a) Prosecution’s Submissions on Sentencing dated 16 September 2019

(“PSS”);

(b) Prosecution’s Submissions on Respondent’s Argument of Inordinate

Delay dated 17 September 2019 (“PSD”);

(c) Prosecution’s Supplementary Submissions on Sentencing dated 12

November 2019 (“PSUP”);

10

Tendered by the Respondent

(d) Submissions for Mitigation for Dr Wang Kit Man dated 17 September

2019 (“RSM”); and

(e) Supplementary Submissions for Mitigation for Dr Wang Kit Man dated

12 November 2019 (“RSUP”).

9. Counsel for the SDC and the Respondent also made oral submissions to the

Disciplinary Committee at the hearing on 19 November 2019.

10. In summary :

(a) SDC Counsel submits that the appropriate sentence in relation to the

Amended 3rd Charge (taking the Amended 5th Charge into account)

is as follows :-

(i) the Respondent be fined the sum of S$10,000;

(ii) the Respondent be censured;

(iii) the Respondent is to give a written undertaking to the SDC not

to repeat the offences the Respondent has been convicted of;

and

(iv) the Respondent is to pay the costs and expenses of and

11

incidental to this Disciplinary Committee inquiry, including the

costs of legal counsel to the SDC and the Legal Assessor

– see PSUP [13].

(b) Respondent’s counsel submitted that he should be punished with a

“reasonable find with censure and undertaking” – see RSUP [13]. At

the hearing on 19 November 2019, Respondent’s Counsel clarified

that the Respondent’s position was that he should be fined not more

than S$5,000.

11. As to the appropriate approach to be taken in respect of sentencing, both the

SDC and the Respondent were in general agreement at the 19 November

2019 hearing (despite what the SDC had submitted earlier in PSS and PSUP)

that the sentencing framework set out in Wong Meng Hang v Singapore

Medical Council [2018] SGHC 253 (“Wong Meng Hang”) ought not to be

applied by the Disciplinary Committee in respect of the Amended Third

Charge (a charge of failing to keep sufficient records of a patient’s care and

management), following the approach in Singapore Medical Council v Dr Tan

Kok Jin [2019] SMCDT 3 (“Tan Kok Jin”) at [37] and Singapore Medical

Council v Dr Mohd Syamsul Alam bin Ismail [2019] SGHC 58 (“Syamsul”).

We agree.

12. That said, SDC Counsel submitted that the sentence that it had submitted as

being appropriate (which included a S$10,000 fine) would be appropriate

regardless of whether one were to apply the sentencing framework in Wong

12

Meng Hang or use some other method to determine the appropriate sentence.

13. Both SDC Counsel and Respondent’s Counsel urged us to consider past

precedents to determine the appropriate sentence. SDC Counsel placed

great emphasis on the SDC Case of Dr Sng Wee Hock dated 9 May 2019

(“Sng”) which in turn, relied heavily on the Singapore Medical Council

(“SMC”) case of Dr Lim Chong Hee dated 4 May 2012 (“Lim”). In Sng, the

SDC imposed inter alia an S$8,000 fine on the dental practitioner for his

failure to keep clear and adequate dental records of his patient. In Lim, the

SMC imposed inter alia a S$5,000 fine on the medical practitioner for failing

to record, in his clinical records, his discussion with his patient in relation to

(a) a possible lobectomy and (b) the patient’s consent to the lobectomy.

Respondent’s counsel also urged us to be guided by Lim in terms of the

appropriate fine to be imposed – see RSUP [10] and [11].

14. Further, SDC Counsel placed reliance on [36] of Sng, where the SDC

Disciplinary Committee stated (emphasis added) :-

“36 The DC agree with the view expressed in [Lim] that the normal tariff

for failure to keep proper records should be about S$10,000. In the

present case however, as some records were kept by the Respondent, the

DC was prepared to consider a slight penalty in his favour.”

The SDC’s submission was essentially that we should apply the same “tariff”

in Lim and Sng.

13

15. We are unable to agree with the SDC’s proposed approach for various

reasons. First, Sng appears to have applied the “tariff” in Lim without taking

into account that in Lim, the maximum fine was S$10,000 (far lower than the

current maximum fine of S$100,000). Second, Lim was decided before the

‘re-calibration’ of precedents prompted inter alia by Singapore Medical

Council v Wong Him Choon [2016] SGHC 145 9 (“Wong Him Choon”). As

such, the worth of Lim as a useful precedent is tenuous.

16. In any event, we decline to follow precedent blindly. As stated by the Court

of Three Judges in Lee Kim Kwong v Singapore Medical Council [2014] 4

SLR 113 (at [45]), although a measure of consistency with sentencing

precedents is a consideration, “fidelity to precedent ought not to lead to

ossification of the law”.

17. For these reasons, we reject the submission that there is a “normal tariff” for

failure to keep proper records. If arguendo, there is a “normal tariff”, we also

disagree that the said tariff today is S$10,000, especially against the backdrop

of a maximum fine of S$100,000 for SMC cases (or S$50,000 for SDC cases).

18. In our view, the better approach (which we adopt) is as follows :-

(a) The starting point in relation to a failure to maintain sufficient

documentation and/or clinical records is as stated in Yong Thiam Look

Peter v Singapore Medical Council [2017] 4 SLR 66, where the Court

of Three Judges held that a failure to keep adequate records ought

not to be seen as a minor or technical breach. As stated in Syamsul

14

at [12], “[p]roperly kept medical records form the basis of good

management of the patient and of sound communications pertaining

to the care of the patient, and help ensure that the care of patients can

be safely taken over by another doctor should the need arise.” We

agree. In our view, the consequence of a failure to keep adequate

records should therefore ordinarily be a substantial fine, or where the

case is egregious, a suspension e.g. the 3-month suspension ordered

by the Court of Three Judge in Syamsul.

(b) Next, (i) whether a fine or suspension should be ordered, and (ii) the

appropriate amount of fine or length of suspension, should be

determined by reference to the severity of the practitioner’s deviation

from the standards expected of him i.e. the extent to which his conduct

fell below the standard of sufficient documentation as required by

Clause 4.1.2 of the ECG, reproduced below, for convenience

(emphasis added) :-

4.1.2. Dental Records

Proper documentation is a hallmark of quality dentistry and a

standard of care that patients have come to expect from the

profession. All treatment records maintained by dentists

shall therefore be clear, accurate, legible and

contemporary. All records shall be of sufficient detail so

that any other dentist reading them would be able to take

over the management of a case. All clinical details,

investigation results, discussion of treatment options,

informed consents and treatment by drug or procedures

should be documented …

Much therefore depends on the facts; a more serious deviation from

15

the above standards will sound in a more serious punishment, a vice-

versa.

19. With this approach in mind, we now turn to the facts of this case. Having

regard to the paucity and often illegible nature of the Respondent’s clinical

notes (see e.g. ABD pages 4 and 9), and the Respondent’s own admission

that he failed to maintain sufficient documentation in respect of the Patient’s

condition, treatment and care (see [4] above), it would ordinarily have been

appropriate for us to consider a punishment at the high-end of the range of

fines, or even a suspension. However, on the facts of this case, we note the

following :-

(a) As the SDC has rightly concerned, no significant harm resulted from

the Respondent’s poor record-keeping. Indeed, we are of the view

(as stated at Plea of Guilt Decision [36]) that based on the evidence

before us, the intractable pain that the Patient experienced following

the implant placement and its subsequent failure was atypical and was

not contributed-to by the Respondent’s substandard record-keeping.

(b) As Respondent’s Counsel submitted, and as SDC Counsel rightly

conceded, at the hearing on 19 November 2019, the substandard

documentation of the Respondent was in no way comparable with the

deeply substandard record keeping in Syamsul. Syamsul was a much

more serious case, by far. For that reason also, we declined to regard

Syamsul as setting a precedent or “tariff” such that a failure to keep

proper or sufficient documentation would attract a suspension of three

16

months (which is what the Court of Three Judges ordered on the

specific facts of that case).

(c) Indeed, the facts of this case were quite different from Syamsul, where

e.g. there was every likelihood that another doctor (i.e. a different

doctor from Dr Syamsul) would see the patient on his next visit and

would have to rely on the notes previously written by Dr Syamsul. On

the facts of this case, although the Respondent was part of a group

practice, he was the dental practitioner treating the Patient, and he

expected that he would be the dental practitioner seeing her on every

visit to the clinic. To that extent, his documentation – although shoddy

– may well have served as a sufficient aide-memoire to him, of the

patient’s condition and treatment. While this would be insufficient to

meet the requirements of Clause 4.1.2 of the ECG, we are prepared

to give the Respondent the benefit of the doubt vis-à-vis his ability to

read and understand his own notes, thereby triggering his personal

recollection of the Patient’s case, including matters that he did not

sufficiently document.

(d) Perhaps most importantly, despite his substandard documentation,

the Respondent correctly referred the Patient to an oral surgeon – Dr

Yong Loong Tee – and appears to have briefed him sufficiently on the

facts and circumstances of the Patient’s case, such that Dr Yong was

able to take over her treatment and care. This strongly mitigated the

prejudice to the Patient resulting from the Respondent’s substandard

documentation. Putting it another way, although the Respondent’s

17

notes were insufficient to meet the standards required of Clause 4.1.2

ECG, he avoided the potential harm from the substandard conduct by

his referral of the Patient to, and briefing of, Dr Yong.

20. The combination of all of the above factors disposes us to ordering a fine (as

opposed to a suspension) on the facts of this specific case, and in particular,

a fine significantly lower than the maximum of S$50,000, but still of sufficient

gravity to emphasise that the Respondent’s breach of Clause 4.1.2 of the

ECG is by no means minor, or merely technical.

21. We also note the following mitigating factors advanced by the Respondent :-

(a) the Respondent’s unblemished record of about 15 years’ practice;

(b) the co-operation of the Respondent with the SDC, thereby saving time

and costs; and

(c) the Respondent’s plea of guilt in relation to the Amended Third Charge

and his remorse in relation thereto.

22. As such, for the reasons we have set forth above, the Disciplinary Committee

now orders as follows :-

(a) the Respondent be fined the sum of S$10,000;

(b) the Respondent be censured in writing;

18

(c) the Respondent shall give a written undertaking to the SDC not to

repeat the offences he has been convicted of; and

(d) the Respondent shall pay the costs and expenses of, and incidental

to, this Disciplinary Committee inquiry, including the costs of legal

counsel to the SDC and the Legal Assessor.

23. The Disciplinary Committee further orders, pursuant to Regulation 25 of the

Dental Registration Regulations that this Decision and the Plea of Guilt

Decision be published for the benefit of the public.

24. This hearing is hereby concluded.

Dated this 19th day of November, 2019.

Dr Kaan Sheung Kin (Chairman)

Dr Seah Tian Ee

Dr Lee Chi Hong Bruce

Dr Rachael Pereira (Layperson)